Travel incident report

The notifier

Circumstances of the incident

Period of the trip

Cost type

Claim for compensation

Addition of documents

Please add all the necessary materials (for example the notice from the accident, copied of documents, photos of the vehicles and the scene of the event). You may forward the documents also later to your claims handler or send them separately via

When submitting the claim, I confirm that all the information is correct and verifiable if needed. When submitting the claim, I give permission to the insurance company to process personal data and to receive information from third parties, which is necessary to determine the extent of the obligation or performance of the insurance contract.
Save and submit the claim?